The total sample size (N) in each category and each screening Her 5-year risk is 2.3%, which is above the 0.55% threshold for a 3-year return, so the recommended management is 1-year follow-up. The work cannot be changed in any way or used commercially without permission from the journal. The 2019 guidelines comprehensively use and expand upon the principle of “equal management for equal risks” that was introduced in the 2012 guidelines.2 Specifically, management is based on a patient's risk of CIN 3+, regardless of what combination of test results yields that risk level. J Lower Gen Tract Dis 2020;24:102–131. Abnormal Screening NCI-Kaiser Permanente Northern California (KPNC) Persistence and Progression (PaP) study have been reapproved yearly by both KPNC and NCI Institutional Review Board review committees. The tables presented here display the risk estimates of CIN 3+, as well as CIN 2+ and Implementing the 2019 ASCCP Risk Based Management Guidelines for Abnormal Cervical Cancer Screening Tests in Your Practice Patty Cason, MS, FNP-BC Envision Sexual and Reproductive . Examples of important results are highlighted; for example, the risk posed by most current abnormalities is greatly reduced if the prior screening round was HPV-negative. Disclosures Cason Member board of directors ASCCP. Data is temporarily unavailable. Observing one more negative HPV test result decreases this risk to 0.44%, which leads to 3-year follow-up (see Table 5B). This patient has a history of treated CIN 3, therefore consult Table 5A. ; HPV-positive NILM × 2, HPV-positive ASC-US, or HPV-positive LSIL) at which CIN 1 or less was confirmed via biopsy, minor abnormalities (e.g., HPV-positive ASC-US and HPV-positive LSIL) found on the first follow-up test are recommended to be followed in 1 year, rather than proceed immediately to colposcopy (see Table 4A). This study was partly supported by the Intramural Research Program of the US National Institutes of Health (NIH)/National Cancer Institute (NCI). (2020) 2019 ASCCP Risk-Based Management Consensus Guidelines … By continuing to use this website you are giving consent to cookies being used. This patient has an abnormal current result and an unknown/undocumented history, therefore consult Table 1A. We also lay out basic principles underlying risk-based management: (a) HPV-negative test results reduce risk; (b) colposcopic examinations at which CIN 2+ is not found reduce risk; (c) HPV-positive test results increase risk; and (d) prior treatment for CIN 2 or CIN 3 increases risk. Patient 3: A 32-year-old woman presents for follow-up. They employ HPV-based testing as the basis for risk estimation, allow for perso … To qualify for Table 1B, a patient's current abnormal screening test result must be preceded by a negative HPV test documented in the medical record within the past approximately 5 years (e.g., a normal screening interval). The QRISK ® 3 algorithm calculates a person's risk of developing a heart attack or stroke over the next 10 years. test results. The first screening round will detect most prevalent CIN 3+ and reduce the risk of CIN 3+ in future screening rounds. With this strong caveat, a recommendation confidence score above 80% is suggested as a helpful guide by the statisticians directing the analyses to represent good reassurance for the recommended management, although again there is no absolute threshold for such a statistical intuition. A user-friendly, electronic presentation of these risk estimates and their related recommendations is available via a smartphone app, and a web version (available via asccp.org). The Next Generation of Guidelines: It’s All About Risk . CIN 2 was de-emphasized because it is a less reliable histopathologic definition of precancer. A study of partial human papillomavirus genotyping in support of the 2019 ASCCP risk-based management consensus guidelines. Health. Reaching the 60% threshold for preferring treatment requires an additional risk factor, such as HPV-16 infection7 or a history of not having been screened. your express consent. Two central questions underlie risk estimations: (a) What are the current results? Patient 5: A 32-year-old woman has a history of an HPV-positive LSIL result, followed by a colposcopic biopsy showing CIN 1. Following the risk estimates columns, recommended management and “Recommendation She presents for follow-up at 1 year and her cotest result is HPV-positive ASC-US. ASCVD Risk Estimator Intended for patients with LDL-C 190 mg/dL (4.92 mmol/L), without ASCVD, not on LDL-C lowering therapy. The National Cancer Institute (including M.S. The 2019 American Society for Colposcopy and Cervical Pathology Risk-Based Management Consensus Guidelines for the management of cervical cancer screening abnormalities recommend 1 of 6 clinical actions (treatment, optional treatment or colposcopy/biopsy, colposcopy/biopsy, 1-year surveillance, 3-year surveillance, 5-year return to regular screening) based on the risk of cervical intraepithelial neoplasia grade 3, adenocarcinoma in situ, or cancer (CIN 3+) for the many different combinations of current and recent past screening results. result as a percentage (%) of total screened, the total number of patients informative in risk estimation (N However, ancillary analyses considered CIN 2+ (CIN 2/CIN 3/AIS/cancer) as an alternative definition of precancer and cancer by itself as an alternative outcome (please refer to the comprehensive tables available online at https://CervixCa.nlm.nih.gov/RiskTables). The 2019 ASCCP Risk-Based Management Consensus Guidelines (Perkins and Guido et al.) 2. Generation of these risk estimates was supported by the Intramural Research Program of the National Cancer Institute. The only instance in which HPV-negative is not reassuring is when cytology is HSIL+. Her current test results are HPV-positive ASC-US. 1. [email protected]. presented with its corresponding standard error (SE) and 95% lower (LL95) Her 5-year risk is 0.91%, which is above the 0.55% threshold for a 3-year return, so the recommended management is 1-year follow-up. Reset All. 2019 ASCCP Risk-Based Management Consensus Guidelines: Methods for Risk Estimation, Recommended Management, and Validation April 2020 Journal of … Her 5-year risk is 6.0%, which is above the 0.55% threshold for a 3-year return, so the recommended management is 1-year follow-up. The new risk-based guidelines present recommendations for the management of abnormal screening test and histology results; the key risk estimates supporting guidelines are presented in this article. An HPV-negative test is virtually as reassuring as a negative cotest. We report the total number of patients and the number of CIN 3+ cases reported among those patients for each combination of “current results” and “history.” We present the number and percentage of the population with corresponding current test results in columns “n” and “%,” respectively. However, to maximize safety after treatment of precancer, management is recommended based on the risks of patients treated for CIN 3. Histopathology was also centralized. Scenario 4 describes management after a colposcopy at which CIN 2+ was not found (i.e., colposcopy/biopsy results were CIN 1 or normal). Even after 3 negative HPV tests or cotests, risks remain well above the 0.15% 5-year CIN 3+ risk threshold needed to return to screening at 5-year intervals, leading to a recommendation of continued follow-up at 3-year intervals. In the KPNC database, 2,379 women had this result combination, among whom 12 had CIN 3+, leading to a recommendation confidence score of 91%. 4. Mixture models for undiagnosed prevalent disease and interval-censored incident disease: applications to a cohort assembled from electronic health records. treatment for CIN 2 or CIN 3. Moving from result-based to risk-based guidelines, it is important for the clinician to understand how these risk estimates were obtained and how to use them in clinical management of cervical screening. For instance, a “Recommendation confidence score” of 95% for a recommendation of 1-year surveillance means 95% statistical confidence that the recommended management is correct when considering the KPNC data, rather than colposcopy or 3-year surveillance. Among the 8% of the population that initially tested HPV positive, immediate CIN 3+ risks ranged from 2.1% for HPV-positive NILM (below the colposcopy threshold), to 4.3% and 4.4% for HPV-positive ASC-US and LSIL, respectively (defining the colposcopy threshold), to 25% and 26% for HPV-negative HSIL+ and HPV-positive ASC-H, respectively (defining the treatment or colposcopy threshold), to 49% for HPV-positive HSIL+. of colposcopy/biopsy results, Surveillance visit In Table 4B, “history” again refers to both the colposcopy result (